经肛吻合器直肠切除术治疗女性出口梗阻型便秘临床效果观察

目的:探讨经肛吻合器直肠切除术（STARR）治疗以直肠前突（或合并直肠黏膜内脱垂）为主的女性出口梗阻型便秘的临床疗效。方法:简介手术所用的肛肠吻合器。对58例以直肠前突（或合并直肠粘膜内脱垂）为主要病因的女性出口梗阻型便秘患者实施STARR手术前后的主观感受、便秘评分、排粪造影进行分析比较。结果:术后所有病人主观感觉排便困难症状缓解,排便较术前畅通;术后1周、1月、3月与术前便秘评分比较差异有统计学意义（P<0.05）;术后1、3月排粪造影结果提示直肠前突、直肠黏膜内脱垂较术前明显好转（P<0.01）。结论:STARR手术是治疗以直肠前突（或合并直肠粘膜内脱垂）为主因的女性出口梗阻型便秘的一个安全有效的手术方式,但应严格掌握其适应证。     

改良经肛双吻合器直肠部分切除吻合术治疗直肠内套叠合并前突的临床疗效观察

目的:研究改良经肛双吻合器直肠部分切除吻合术治疗直肠内套叠合并前突患者的临床疗效.方法:回顾性分析2018年6月至2020年6月我院收治的直肠内套叠合并前突的患者的临床资料.根据手术方法不同分为改良STARR(Stapled transanal rectal resection,STARR)组和STARR组各45例.对...     

双吻合器在全直肠系膜切除低位直肠癌保肛手术中应用的探讨

目的 探讨双吻合器在全直肠系膜切除低位直肠癌保肛手术中的应用方法、并发症及临床效果.方法 回顾性分析在全直肠系膜切除的基础上,应用双器械吻合技术,对48例中低位直肠癌行低位或超低位吻合的保肛手术方法,观察其术后并发症,以及术后排便功能,局部复发率.结果 随访1～4年,低位吻合44例,超低位吻合4例.15例6个月内大便次数每天多于5次,6个月后大便次数均在每天3次以下,无大便失禁.吻合口漏1例,吻合口狭窄1例,吻合口出血3例,吻合口复发1例,全组无手术死亡.结论 双吻合器能简化手术操作,维持正常排便功能,提高了生活质量.     

Comparison of standard 4-row versus 6-row 3-D linear cutter stapler in creation of gastrointestinal system anastomoses: a prospective randomized trial

OBJECTIVE:

This prospective study was conducted to compare the clinical outcomes of a 6-row 3-D linear cutter with the standard 4-row linear cutter in patients who underwent elective gastrointestinal surgery anastomosis.

METHOD:

Patients who underwent elective open gastrointestinal surgery that included stapled anastomosis using a linear cutter (Proximate®, Ethicon Endo-Surgery, Cincinnati, OH) between January 2011 and May 2011 were included in the study. The patients were randomly assigned to two groups according to the linear cutter that was used in the surgery: the standard 4-row cutter (the S group) or the new 6-row cutter (the N group). The groups were compared based on the patient demographic data, the laboratory parameters, the preoperative diagnosis, the surgery performed, the operation time, intra- or postoperative complications, the time to oral tolerance and the length of the hospital stay.

RESULTS:

The S group included 11 male and nine female patients with a mean age of 65±12 (35-84) years, while the N group included 13 male and eight female patients with a mean age of 62±11 (46-79) years (p = 0.448, p = 0.443, respectively). Anastomotic line bleeding was observed in eight (40%) patients in the S group and in one (4.7%) patient in the N group (p = 0.006). Dehiscence of the anastomosis line was observed in two (10%) patients in the S group and none in the N group (p = 0.131). Anastomotic leakage developed in three (15%) patients in the S group and in one (4.7%) patient in the N group (p = 0.269). The mean hospital stay was 12.65±6.1 days in the S group and 9.52±2.9 days in the N group (p = 0.043).

CONCLUSION:

The 6-row 3-D linear cutter is a safe and easily applied instrument that can be used to create anastomoses in gastrointestinal surgery. The new stapler provides some usage benefits and is also superior to the standard linear cutter with regard to anastomotic line bleeding.     

Multiscale active contour model for vessel segmentation

This paper presents a novel multiscale active contour model for vessel segmentation. The model is based on accurate analysis of the vessel structure in the image. According to different scale response of the eigenvalues of local second order derivative (Hessian matrix), a new vessel region information function, which shows a valid estimation of the vesselness measure, is defined. We introduce the posteriori probability estimation into the active contours framework and design a new objective function. The defined objective function is minimized using the variational method, and a new region-based external force is obtained, which is more accurate to the vessel structure and not sensitive to the initial condition. This active contour model combines the obtained region-based and conventional boundary-based force, which aims at finding more accurate vessel edges even when the vessel branches are low contrast or blurry. Furthermore, the proposed model is implemented by an implicit method of level set framework, the solution of which is steady and suitable for various topology changes. Moreover, two new speed functions for vessel segmentation in the level set method are presented, one for fast marching and the other for a narrow-band algorithm. The vessel segmentation experiments compared with previous geometric active contour models are shown on several medical images. The experimental results demonstrate the performance of our approach.     

A novel active contour model for serial image segmentation

A novel method for the segmentation of serial images is proposed. In the presented framework, the driving force acts as the attracting term to propel the evolving curve towards the object boundaries, and the adaptive term changes the sign of driving force accordingly. Therefore, the evolving curves can arrive at the desired direction without a requirement for the initial curve to be strictly inside or outside the object. A weighted length term is used to keep the smoothness of curve and penalize the formulation of discontinuities. To prevent the level set function deviating from a signed distance function, a distance rectifying flow is also added to the model; therefore the time-consuming re-initialization procedure is completely avoided. Experiments on both synthetic image and CT serial images demonstrate the feasibility and efficiency of the method.     

An active contour model algorithm for tracking endocardiac boundaries in echocardiographic sequences

The use of active contour models to track the boundaries of anatomic structures in medical images is a technique that has attracted a great number of efforts during the last decade. Segmentation techniques based in deformable active contours were proposed first by Kass et al. Because of the problems appearing using these models, some solutions have been introduced, such as balloon force or Gradient Vector Flow force (GVF), derived from the Gradient Vector Flow vectorial field. Results obtained with these forces in the tracking endocardiac task in echocardiographic sequences were not adequate. We have designed a new external force called hybrid force, which, by combining both forces, joins the main features of each one.     

Reduced top-down influences in contour detection in schizophrenia

Introduction. Chronic schizophrenia patients have previously demonstrated performance deficits in contour integration tasks. The purpose of this study was to investigate whether schizophrenia patients, spanning a range of illness severity, would demonstrate responsiveness to manipulations that recruit top-down processing strategies involving learning and sequencing effects in a contour integration task. Methods. We administered a contour integration test over four consecutive days and in two different presentation conditions each day. In one condition, the stimuli were administered in order of increasing difficulty, and in the other they were presented in random order. The order in which these two conditions were presented was counterbalanced across days and participants. In addition, a nonschizophrenia psychotic disorders control group was included to determine if past findings of a contour integration deficit in schizophrenia could be replicated in the presence of a symptomatically similar control group. Results. All groups demonstrated similar learning curves across the four days and generally similar overall levels of performance, with the exception of the group of the most chronic schizophrenia patients. In addition, the order in which the stimuli were presented to subjects affected their performance, with higher scores achieved for all groups in the condition where the stimuli were presented in increasing order of difficulty. Interaction effects revealed that the effects of order presentation were greater for nonpatient than for psychotic patients. Conclusions. These data are further evidence that perceptual organization impairments in schizophrenia are illness severity-related, and that schizophrenia patients as a whole are less sensitive to top-down manipulations in this type of task.